Post-traumatic neck pain after a high-velocity hyperextension injury is the most common presentation. Neurological impairment is seen only in 25% of patients.
This is known as a 'judicial lesion' as these are the forces delivered by a noose, which, contrary to most ill-informed depictions, was placed with the knot towards the side of the neck, next to the angle of the mandible/mastoid process.
This fracture is virtually never seen in suicidal hanging. Indeed, it was not even seen in many of those who were judicially hanged; asphyxiation being the usual mode of death. Major trauma in hyperextension, such as a high-speed motor vehicle accident, is, in fact, the most common association – especially in fatal cases.
- bilateral lamina and pedicle fracture at C2
- usually associated with anterolisthesis of C2 on C3
Treatment and prognosis
Treatment can be bracing or, more typically, internal fixation.
History and etymology
The term "hangman fracture" was introduced by Schneider in 1965 5. Strictly speaking, the fracture is misnamed and should more correctly be called "hangee" fracture. As a historical note, there are four methods of judicial hanging, and the process is more complicated than may be evident at first glance.
- check for an extension to the transverse foramina and, if present, vertebral artery injury should be considered
- fractures by location
- cervical spine fracture classification systems
- thoracolumbar spinal fracture classification systems
- three column concept of spinal fractures (Denis classification)
- classification of sacral fractures
- facet dislocation
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- 2. Mirvis SE, Young JW, Lim C et-al. Hangman's fracture: radiologic assessment in 27 cases. Radiology. 1987;163 (3): 713-7. Radiology (citation) - Pubmed citation
- 3. Parisi M, Lieberson R, Shatsky S. Hangman's fracture or primary spondylolysis: a patient and a brief review. Pediatr Radiol. 1991;21 (5): 367-8. - Pubmed citation
- 4. Longstreth WT, Cohen W, Reay DT. Hangman's fracture. J Neurosurg Spine. 2011;15 (5): 576. doi:10.3171/2011.3.SPINE11206 - Pubmed citation
- 5. Rayes M, Mittal M, Rengachary SS et-al. Hangman's fracture: a historical and biomechanical perspective. J Neurosurg Spine. 2011;14 (2): 198-208. doi:10.3171/2010.10.SPINE09805 - Pubmed citation